Components Analyses of a School-Based Cognitive Behavioral Treatment for Youth Depression.

The current study sought to build upon research on cognitive behavioral therapy (CBT) as the first-line treatment for depressed youth by investigating the effects of the various components of a CBT treatment on changes in depressive symptoms in young female participants. Female participants 9-14 years of age (n = 40; M age = 10.58 years) with a diagnosis of a depressive disorder from the CBT-only treatment condition of a larger randomized clinical trial were included in the current study. Participants engaged in a 20-session, 11-week, school-based CBT group intervention (ACTION Treatment; Stark et al., 2006). Depressive symptoms were assessed pre- and posttreatment, and intervention components were coded based on review of audio recordings of treatment sessions. Data were examined using two-level mixed-effects models using hierarchical linear modeling with full maximum likelihood estimation. Results indicated that higher quality behavioral intervention components were associated with greater improvement in posttreatment depression scores, higher quality cognitive intervention components were marginally associated with worsening posttreatment depression scores, and relational intervention components were not associated with depression outcome. Age significantly moderated the relationships between intervention components and depression outcome, with younger female participants benefiting most from higher quality behavioral and relational intervention components. These findings provide preliminary evidence about the differential impact of CBT components on depression treatment outcome for young female participants, with consideration of age as a moderator. This study highlights the importance of continuing to dismantle CBT treatment components for youth depression, as such findings can be used to design more potent, developmentally tailored interventions.

Family accommodation mediates the association between anxiety symptoms in mothers and children.

OBJECTIVE: The link between child anxiety and maternal anxiety has been well established but the factors underlying this association are not well understood. One potential factor is family accommodation, which describes ways in which parents change their behaviour to help a child avoid or alleviate anxiety. Family accommodation has been associated with greater symptom severity, more impairment and poorer treatment outcomes in the child. The aim of this study was to investigate whether maternal accommodation mediates the relation between parent and child anxiety. METHOD: Mothers of children (N = 85) aged 7-17 years (M = 11.79) completed measures of their own anxiety (State-Trait Anxiety Inventory (STAI)), their child's anxiety (Screen for Child Anxiety Related Disorders (SCARED)), and family accommodation (Family Accommodation Scale Anxiety (FASA)). Structural equation modelling (SEM) was used to test the mediational role of accommodation linking parent and child anxiety. RESULTS: Family accommodation was found to significantly mediate the link between maternal anxiety and child anxiety. CONCLUSION: These results inform theory and imply that the development of interventions designed to target family accommodation may improve the prognosis of those diagnosed with paediatric anxiety disorders and youth with subclinical anxiety symptoms by reducing both parent and child anxiety.

Implementation of ACTION: A Case Example.

The ACTION treatment program was developed as a school-based CBT program for girls in grades 3 to 6 to address depression. It has shown to be effective in reducing depressive symptoms and disorders. The treatment relies on a strong case conceptualization and follows a treatment protocol that is used to help children learn and apply coping skills, problem-solving, and cognitive restructuring. A case description is presented to give a detailed example of how this treatment protocol can be applied in individual therapy, and an emphasis on the therapists' thoughts and decision-making points is highlighted. Many subtle aspects to treating depressed youth are described.

Hopelessness and depressive symptoms in children and adolescents: An integrative data analysis.

Although hopelessness has been linked to depression for centuries, the diagnostic criteria for depression are inconsistent with regard to the status of hopelessness. Most research on hopelessness and depression has focused on adults. The current study examined this relation in children and adolescents. Integrative data analyses with a pooled sample (N = 2466) showed that clinical levels of hopelessness multiplied the odds of having a clinical diagnosis of depression 10-fold. Conversely, not having clinical levels of hopelessness multiplied the odds of endorsing no clinical level of depressive symptoms 28-fold. Moreover, results differed by levels of depression: (a) among youths with clinical levels of depression, hopelessness was associated with six depressive symptoms; (b) among youths without clinical levels of depression, hopelessness was associated with nine depressive symptoms. We found that hopelessness helps to explain the heterogeneity of depressive presentations. Our finding supports the consideration of hopelessness in the diagnosis (if not treatment and prevention) of depression in children and adolescents. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychometric properties of the Beck Depression Inventory for Youth in a sample of girls.

A new measure has been developed to assess depressive symptoms, the Beck Depression Inventory for Youth (BDI-Y; J. S. Beck, A. T. Beck, & J. B. Jolly, 2001). This research extends previous validation research of BDI-Y total scores by examining internal consistency and convergent and predictive validity within a school-based sample (n=859) of girls 9-13 years old by age level and for selected races or ethnic groups. Scores had high internal consistency, and there was support for using the BDI-Y to assess depressive symptoms. Reliability was slightly lower for 9-year-olds, but reliability and validity estimates did not differ by race or ethnic group. Finally, confirmatory factor analysis results provide some support for unidimensionality of scores but also point toward possible refinements.

Cognitive factors differentiating attention deficit-hyperactivity disorder with and without a comorbid mood disorder.

Mood disorders and attention deficit-hyperactivity disorder (ADHD) co-occur in 20-30% of children and adolescents diagnosed in both epidemiological and clinical studies, but little information is available regarding cognitive factors that may be relevant to the expression of co-occurring mood disorders and ADHD. This study examined whether ADHD with and without a comorbid mood disorder could be differentiated on the basis of cognitive factors associated with prominent theories of depression. Children meeting diagnostic criteria for ADHD (n = 14) or ADHD and a comorbid mood disorder (n = 27) were assessed on a variety of cognitive indices. Children in the comorbid group reported more negative views of themselves and a more depressogenic attributional style. Cognitive disturbances associated with A. T. Beck's (1967) cognitive model and attributional style theories of depression differentiate ADHD children with significant mood pathology.

Structure and measurement of depression in youths: applying item response theory to clinical data.

Our goals in this article were to use item response theory (IRT) to assess the relation of depressive symptoms to the underlying dimension of depression and to demonstrate how IRT-based measurement strategies can yield more reliable data about depression severity than conventional symptom counts. Participants were 3,403 children and adolescents from 12 contributing clinical and nonclinical samples; all participants had received the Kiddie Schedule of Affective Disorders and Schizophrenia for School-Aged Children. Results revealed that some symptoms reflected higher levels of depression and were more discriminating than others. Furthermore, use of IRT-based information about symptom severity and discriminability in the measurement of depression severity was shown to reduce measurement error and increase measurement fidelity.